The overall goal of this project is to develop, test, implement, and disseminate a toolkit for primary care offices and health centers to improve the safety of their testing processes. In our previous research we have discovered that errors in testing and test results management account for at least 25% of the errors observed in family medicine offices. National Ambulatory Medical Care Survey data indicate that an average four-physician family practice center manages about 30 diagnostic test reports per day, 150 per week, and 7,500 per year, and each test report may contain one to 20 individual test results. This implies a huge risk to patient safety in primary care. Moreover, research shows that at least a quarter of malpractice claims in primary care are due to testing problems. Our research team is currently conducting an AHRQ sponsored multi-method risk assessment of the testing process in 10 community health centers of Access Community Health Network (ACCESS). Preliminary findings from our office systems engineering assessments, chart audits, and patient phone interviews indicate a number of deficiencies in the safety of ACCESS health center test management systems. Furthermore, we have discovered significant deficiencies in chart documentation, in notifying patients of tests results, and in explaining the implications of the test results to patients. From our prior research we do not believe these problems are unique to ACCESS health centers. Therefore, there is great need for improving the safety of testing processes and the overall management of testing in primary care practices. We believe that the toolkit we produce will be an effective performance improvement tool to accomplish this goal. The toolkit we aim to develop, which will be available via the Web, DVD, and as a paper version, will contain the following four modules: 1) An education module called Improving Office Testing Processes 101.This module will have three chapters: performance improvement in primary care offices, an overview of safe testing processes, and a medical office safety culture survey packet. 2) An assessment and improvement module will contain tools for assessing and monitoring improvements, a performance improvement guide, and performance improvement tools. 3) A special emphasis module on patient activation and communication will include patient assessment tools, a patient empowerment training guide for office staff and physicians, and a special populations patient followup guide. 4) A special emphasis module on electronic health records will include a checklist for assessing the capacity of an electronic health record (EHR) to support safe testing processes. We will test the toolkit extensively in three waves of ACCESS health centers to produce a refined and easy to use product that will be practical for busy, resource-constrained primary care offices. We will disseminate this nonproprietary toolkit through AHRQ, professional primary care associations, primary care accrediting boards, the American Medical Association, and the Medical Group Management Association. PUBLIC HEALTH RELEVANCE: A large proportion of errors observed in primary care practices relate to testing. This project will provide staff in primary care settings with materials to use to eliminate errors and improve the safety of testing for patients. These materials will also serve to raise staff awareness about improving quality and safety more generally.